surgery can accelerate mets

Teild

This is great, surgery can actually accelerate mets by causing dormant cancer cells to become active.  Might effect up to 20% of node positive cases.

http://breast-cancer-research.com/content/6/4/R372

swimangel72

This study was published May 14 2004. I remember reading something about it in the Science Times - I found it very interesting then (before I was dx'd), but have been surprised with a lack of newer information.

LRM216

And what might the alternative be?  Just leave it there?  Either way, I honestly believe this is all a crap shoot - just the roll of the dice.  I hate this $hitty disease with a passion.

Linda

otter

Teild, that is not a research article, despite the way it is labeled on the website.  It is a "hypothesis" the authors are offering to explain some odd things that happen in cancer patients and in mice.

The authors did not do any real research.  All they did was dredge up some data from a clinical study that was done in 1995 on breast cancer patients that were, or were not, treated with chemotherapy (CMF).  Basically, that study found that premenopausal women who had positive nodes and were treated CMF were less likely to develop mets than women who did not get CMF.  At least, that's the part of the study that is relevant to the speculation in the paper you cited.

The authors also mention some research that was done in mice that is relevant to their hypothesis.  When mice are injected with suspensions of tumor cells, the tumor cells can sit dormant in the tissues until a larger tumor of the same type is removed surgically.  The surgical removal of the large tumor provides some sort of stimulus to the artificial "metastatic tumors", and they begin to grow.  That is not news--it was done a long time ago--but it is very interesting and possibly relevant to what happens in people.

So, the authors of this "hypothesis" paper are speculating that the phenomenon observed in mice might explain why women with positive nodes (i.e., their tumors have already spread) are sometimes dx'd with metastatic BC within a year or two after their primary dx.  They are also speculating that the mouse phenomenon might explain why chemotherapy works so well in young women with positive nodes:  it kills those little mets, just as they are beginning to grow after the surgeon removed the primary tumor.

But, there was no research done to test the authors' hypothesis.  They did not do a clinical trial.  The 1995 study to which they referred when discussing their hypothesis was not even very useful, because that study was too old to have included results of ER and PR testing or HER2.

And, as Linda said, what else are we supposed to do--leave the tumor in there?  If there is a message in all this, it's that chemo works best when given fairly soon after the primary surgery, and it works best when the tumor is a variety of BC that grows rapidly and spreads quickly.

But, we already knew all that.

otter 

Teild

I agree that we all have no choice but to have surgery, but this "hypothesis" and similar articles and studies from 2004-2006 do indicate that pre-menopausal node-positve women who have surgery may bring on metastasis a year or two quicker than they might otherwise endure.  I guess that's why it is so important to have chemo in a timely manner if you need it.  But what about excisions and biopsies? . . or positive margins only to be followed up by more surgery months later.  Do they set this process in motion before we know it and well before chemo starts? 

otter

Teild, your questions about the type and extent of surgery that would trigger the "mets explosion" are good ones. I doubt anyone knows the answers (anyone here, or in the medical oncology community).  That's because no one really knows exactly what factors are responsible for that blast of tumor growth after removal of the primary tumor.  There are, again, lots of hypotheses based on mouse studies or experiments done in tissue culture dishes, or based on measuring various growth factors or suppressors that are in the blood.

But, whether any of that is biologically relevant--whether it really is the key to that 2-year period of susceptibility most of us have after our definitive surgery, is still anyone's guess.

Also, you said this:   "...this 'hypothesis' and similar articles and studies from 2004-2006 do indicate that pre-menopausal node-positve women who have surgery may bring on metastasis a year or two quicker than they might otherwise endure."

I want to re-emphasize that the "hypothesis" article doesn't "indicate" anything.  There is no data--no evidence--provided by the authors to show that they have tested their hypothesis.  All they've done is speculate--guess--about the reason for the rapid onset of mets in some pre-menopausal, node-positive women. They may have better credentials than you or I have, but we could do the same thing here.   We could speculate--give our own opinions, based on what we've read.

Also, I don't know of any papers from the authors' reference list or from 2004-2006 that reported earlier onset of mets in node-positive women who did have surgery, compared to those who did not have surgery.  That's what you're suggesting in the statement,  "...pre-menopausal node-positive women who have surgery may bring on metastasis a year or two quicker than they might otherwise endure."  The only way to show that would be to do a clinical trial in which node-positive women either had surgery, or did not have surgery; the hypothesis would be that the women who had surgery would develop mets sooner than those who did not have surgery.  That was shown in the mouse studies with the tumor cells that were injected i.v. to simulate dissemination of mets; but to my knowledge, it has not been shown in BC patients--at least, not under the current guidelines and procedures for surgery, radiation, and chemo.

The value of a "hypothesis" paper like the one you've cited is to get researchers thinking.  Normally, they don't publish a "hypothesis", because no well-regarded, peer-reviewed journal would accept it, except perhaps as a letter to the editor.  Any good medical researcher can speculate.  What most of them do with their speculations is to write them into a research proposal and ask for money to test the hypothesis.  That may be what the authors of the "hypothesis" paper are doing right now.  It would take at least 5 years to get meaningful results from a clinical study like that.  That might explain why we haven't heard anything else.  Or, maybe we haven't heard anything because it would no longer be ethical to conduct a clinical study in node-positive women where one group did not get surgery.

Still, this is a very interesting discussion.  I appreciate that you posted the original link, because it's a fascinating phenomenon (if you can forget, for the time being, that it might be happening inside some of us!).

otter 

LRM216

Otter - your posts are terrific.  Thank you.

Linda

Dawnbelle

Hi, Otter... You are just a wealth of info...I have been reading your posts for days.

When my father had renal cancer growing all over his body, bone, brain, lung...suddenly making him terribly ill, 20 years after the kidney tumor was removed, the Doctor told me this...he said "As long as the primary tumor is there....sending signals to these "feeder cells" saying "I am growing & okay"...the cells sit dormant. Once the tumor is removed, signals stop & they all start growing."

NOW....I had two tumors removed from my left breast last Monday, why would I have two if this were true, I have had the larger lump for 3 years? I was told OVER & OVER it was fibrous & to leave it, then I had two.....Again, I was told they were absolutely nothing & to leave them both, oops, wrong, both IDC.....had I known it were cancer, I may have been worried about removing them, but it had already spread, so what truth is there to this??

Will having them removed make all those nasty little cells in my liver, lungs & bone start growing like crazy? I have no idea how bad my diagnoses will be, the same bs who told me to leave them tells me my nodes look great, how much stock can I put in him? I can't understand how I am suppose to make a choice about lumpectomy vs. mastectomy before I know how bad my lymph nodes are....

There is no rhyme or reason, there is no sense, I have read so many stories, so many like diagnoses, that end so differently....

Why did I tell you all this? *shrugs*

Because you seem to make sense, every time I read another thread that scares the hell out of me, you say something fantastic to make it better, too darn bad you don't live next door.

Savannah hugs to you, Otter.

Dawn.

rdrake0

I know a gal who, 10 years ago, had uterine cancer.  She refused surgery saying it would only spread her cancer (through bleeding, is what she says).  She searched and searched until she found a doc who would do radiation only.  Now she says there is a dead lump in her uterus.  And she feels fine!  That doc, by the way has since left the country (he was from Pakistan, I think she said.).

Just thought I'd throw in another story.